HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED f /} 1
Date: Permit Number: 1 �Q c✓y�-oa t1l2
1121
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial t_-� Residential
PERMIT APPLICATION FOR:
Address:
Legal Description:
Property Tax ID#: `7`� f j -� lJ� QI.yV Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
Additional work-to he performed under this permit–check all that appy:
_Mechanical _Gas Tank __Gas Piping Shutters 4ndows/Doors
_Electric —Plumbing i Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ 1(Iq -7 Utilities: Sewer Septic Building Height:
Name Name:
Address: D c? 2 �t ti( (C Company: �a c�a G>
city:�-V0.6r _State: K' Address: 7i�— l� {
Zip Code: - Fax: 7` � � City: /�.�.IZ"Yui Statt`e:n�
Phone No. ?� 0 Zip Code: 2-1 E) Fax:
E-Mail: NA_ct Phone No
Fill in fee simple Title Holder on next page{if different E-Mail n( I <-- at
from the Owner listed above) State or County License C 6C- t Z TC2-
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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SU�'PL-EIVIFNT,.�L C�?NSTEiUCTION, LIEN LAIN INFC}RN�ATIQN
DESIGNER/ENGINEER: �A Not Applicable MORTGAGE COMPANY. "^ Nat Applicable g
Address: Address:
City: State: City:__ State:
Zip: Phone; Zip: Phone: e
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FEE SIMPLE TITLE HOLDER: NA Not Applicable BONDING COMPANY: NA Not Applicable
Name: Name:
Address: Address: 1
City: City:
Zip: Phone: Zip: Phone:
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I certify that no work or installation has commenced prior to the issuance of a permit.
St.Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure x
which is in conflict with any applicable Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such I
structure.Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will,in all respects,perform the work {
in accordance with the approved plans,the Florida Building Codes and St.Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review:room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite t'
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
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_Sign wne ss gent Signature of Contractor/License Halder
STATE OF FLO DA�rJV
STATE OF FLORIDA
COUNTY OF COUNTY OF13—rd
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The for ing instru e t was acknowledged before me The forgoing instrument was acknowledged before me
this day of ULM 20by this_,:I�)_day of A Ua t z 5.+._,20 -1 kn-by
Vt� Cerc_kct �1. beyt
{ ame of person ackno dging) (Name of person acknowledging)
(Signature of Nota bli tate of Florida) {Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known _OR Produced identification
Type of Identification Produced Type of Identification Produced
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Commission No. ,.. •... ea mission No. (Seal)
CONNIE E.LING
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Notary P
,f P My Comm.Expires Sep 19.2017
Revised 07/15/201 '�.,; ;;; Commission #FF 021989 a`�"RY"Ue CHELSEA DEBOLT
REVIEWS FRONT ZONING SUPERVISOR PLANS N M Co .Expires dun 201E
L '� ci�+RisWiRROVE
COUNTER REVIEW REVIEW REVIEW Vf0w, EW
DATE
COMPLETE
INITIALS
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